Provider Demographics
NPI:1013576164
Name:MADRID, KATHERINE A (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:MADRID
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:STIBICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:3365 STATESMAN CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2685
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3365 STATESMAN CT NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2685
Practice Address - Country:US
Practice Address - Phone:616-915-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011154291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical